Just an hour before my debate in the House of Commons on NHS rationing in Devon, NEW Devon CCG wrote to inform me that they are dropping plans to block operations for smokers and the obese. Below is the letter outlining the changes.

Dear Mr Bradshaw,

Re: Urgent and Necessary Measures

As you will know, Northern, Eastern and Western Devon Clinical Commissioning Group (NEW Devon CCG) has been considering measures to control elective and non-elective activity in such a way as to maximise the health benefits of the services we commission and to address our financial issues.

Today we will announce that we will not require patients to undergo weight loss or stop smoking ahead of routine surgery.

Patients will be offered evidence-based guidance on the benefits of weight loss and smoking cessation as part of their healthcare.

This new position follows significant feedback from a wide range of stakeholders across health, social care and professional bodies on the proposed measures.

People with a high BMI and those who smoke will continue to be invited by their GP to quit smoking or lose weight before undergoing surgery but will not be required to do so.

Clinicians on the Governing Body remain of the view that encouraging smokers and those with a high BMI to stop smoking or lose weight will give them a better outcome for any procedure, but more importantly better health outcomes for the rest of their lives.

Clinicians say they need patients to join with them to get the best return on the money people spend on the NHS.

Whilst announcing our decision on weight-loss and stop-smoking, we will be continuing with a series of other measures that have already been announced.

Appropriate consultation will also take place on second hearing aids and criteria for cataract surgery.

The consultation timetable will be announced on 19 December 2014.

If you any general queries they should be directed in the first instance to the information on the CCG website www.newdevonccg.nhs.uk where all details can be found under the About Us tab. If you can’t find an answer to your query there you can contact our PALS team on either 01392 267 665 or 0300 123 1672, or text on 07789 741 099 or email on [email protected]

Yours sincerely,

Tim Burke - Chair & Rebecca Harriott - Chief Officer

Current position
The position on each of the announced interim commissioning positions is as follows:
Not proceeding:
- Changes to pre-surgical requirements for people with reference to BMI
- Changes to pre-surgical requirements for people with reference to smoking
These will be dealt with as evidence based guidelines

Subject to consultation:
- The relative value of second hearing aids
- The relative value of second cataract operations
- Ear microsuction – limited to treatment of mastoid infections and where anatomical abnormalities make other forms of ear irrigation impossible
- Continue to review the evidence of outcomes for shoulder surgery with prior approval of surgery to ensure conservative treatment has been explored during the period of review
- Stopping shockwave therapy for tendinopathies
The CCG will not consider implementing these measures until it has reviewed the outcomes of the consultation.

The following measures are also already under way:
- Further reduce emergency admissions
- Further reduce A&E attendance
- Reduce out of area referrals where the patient’s healthcare needs can be met locally
- Increase clinical support for 111, mental health and dental
- Change some branded drugs to generic drugs
- Reduce the running costs of the CCG
- Special patient messaging for non-elective medical admissions
- Improve quality of continuing healthcare (CHC) referrals
- Management of MRI referrals
- Management of consultant-to-consultant referrals
- Management of dermatology referrals to ensure maximum use of community-based dermatology services
These are in line with good commissioning practice around the country.

Measures still being considered:
- Management of hernias
- Suspension of ultrasound guided injections
- Review of follow-up after general surgery
- Review of follow-up after cataract surgery
- Review of facet joint and lumbar spine injections
- Use of botulinum toxin
- Management of bunions
- Management of haemorrhoids
- Pathways leading to hysterectomy
- Wet AMD pathway compliance and non-sequential anti-VEGF
- Discussions with acute trusts and other CCGs under way on use of Bevacizumb (Avastin) as treatment for wet age-related macular degeneration (WAMD). Implementation has not commenced.
These will be subject to the same rigorous assessment, and consultation if appropriate. Prior to any consultation the CCG will seek assurance that the proposed measures do not discriminate or exacerbate health inequalities, and comply with statutory requirements.